Week 7 - Eating disorders Flashcards
Which of the following best aligns with the DSM-5 definition of eating disorders?
A) Persistent disturbance in eating behavior that results in altered consumption or absorption of food, impacting physical health or psychosocial functioning.
B) Short-term changes in eating behavior that cause minimal impact on physical health or psychosocial functioning.
C) A temporary alteration in eating habits that does not affect physical health or psychosocial functioning.
D) Brief disturbances in eating behavior that lead to improvements in physical health and psychosocial functioning.
A) Persistent disturbance in eating behavior that results in altered consumption or absorption of food, impacting physical health or psychosocial functioning.
Which of the following eating disorders is characterized by an individual being significantly below a body weight that is normal for their age and height, experiencing a fear of gaining weight, and suffering from body image disturbance?
A) Bulimia Nervosa
B) Binge Eating Disorder
C) Anorexia Nervosa
D) Pica
c - anorexia nervosa
(term coined by Gull:
loss of appetite (anorexia) due to a nervous (nervosa) cause)
Who made the formal diagnosis of anorexia nervosa in 1970, distinguishing it from other forms of weight loss?
A) Dr. William Stewart Halsted
B) Dr. Gerald Russell
C) Dr. Walter K. Cannon
D) Dr. John Money
B) Dr. Gerald Russell
DSM-5 diagnostic criteria for anorexia nervosa:
- relentless pursuit of
thinness resulting in weight loss substantially below a normal body weight (e.g., a weight less than 85 per cent of that expected given the individual’s age and height)
- cognitive distortions, including various manifestations of a body image disturbance
(e.g., that the individual’s sense of self-worth is based excessively on his/her shape/weight or that the individual denies the seriousness of his/her low weight)
- intense fear of gaining weight (not in all cases) or engaging in persistent behaviour to avoid gaining weight.
Which of the following is NOT a criterion for the diagnosis of anorexia nervosa according to the DSM-5?
A) Restriction of energy intake leading to a significantly low body weight
B) Intense fear of gaining weight or persistent behavior to avoid weight gain
C) Significant increase in body weight due to compulsive overeating
D) Distorted body image or undue influence of body weight on self-worth
C) Significant increase in body weight due to compulsive overeating
Which of the following statements accurately reflects a criterion for anorexia nervosa according to the DSM-5?
A) All individuals with anorexia nervosa explicitly fear gaining weight and express this fear directly.
B) Some individuals with anorexia nervosa may not verbally express a fear of gaining weight but still engage in persistent behaviors to prevent weight gain.
C) Individuals with anorexia nervosa typically show a lack of concern about their weight and body image.
D) Engaging in persistent behaviors to gain weight is a criterion for diagnosing anorexia nervosa.
B) Some individuals with anorexia nervosa may not verbally express a fear of gaining weight but still engage in persistent behaviors to prevent weight gain.
Which of the following pairs correctly identifies the subtypes of anorexia nervosa according to the DSM-5?
A) Restricting type and binge-eating/purging type
B) Anxious type and depressive type
C) Compulsive type and obsessive type
D) Classic type and atypical type
A) Restricting type and binge-eating/purging type
Binge eating/purging anorexia nervosa is the same as bulimia nervosa. True/False
False
(both involve purging but patients with bulimia nervosa are not underweight)
Which of the following best describes the binge-eating/purging type of anorexia nervosa?
A) Characterized by regular binge eating followed by compensatory behaviors, with normal or above-normal weight
B) Involves episodes of binge eating and purging behaviors, with extreme dietary restriction and significant weight loss
C) Defined by frequent purging without episodes of binge eating, and a normal weight range
D) Involves excessive exercise and a focus on muscle gain rather than weight control
B) Involves episodes of binge eating and purging behaviors, with extreme dietary restriction and significant weight loss
Which of the following statements accurately distinguishes between the binge-eating/purging type of anorexia nervosa and bulimia nervosa?
A) Both disorders involve binge eating and purging behaviors, but individuals with bulimia nervosa typically maintain a significantly low body weight.
B) Binge eating and purging behaviors are present in both disorders, but individuals with bulimia nervosa generally have a body weight that is at or above normal, whereas those with the binge-eating/purging type of anorexia nervosa have a significantly low body weight.
C) The binge-eating/purging type of anorexia nervosa is characterized by compulsive overeating without purging, while bulimia nervosa involves purging without binge eating.
D) Both disorders involve a focus on weight gain prevention, but bulimia nervosa exclusively involves dietary restriction without binge eating.
B) Binge eating and purging behaviors are present in both disorders, but individuals with bulimia nervosa generally have a body weight that is at or above normal, whereas those with the binge-eating/purging type of anorexia nervosa have a significantly low body weight.
Which of the following is the instrument developed for staging anorexia nervosa based on symptomatic severity?
A) Clinician Administered Rating Scale for Anorexia Nervosa (CARS-AN)
B) Eating Disorder Examination Questionnaire (EDE-Q)
C) Anorexia Nervosa Severity Scale (ANSS)
D) Clinician Administered Questionnaire for Anorexia Nervosa (CAQ-AN)
A) Clinician Administered Rating Scale for Anorexia Nervosa (CARS-AN)
Which of the following correctly lists the stages of anorexia nervosa severity according to the Clinician Administered Rating Scale for Anorexia Nervosa (CARS-AN)?
A) Stage 1: Mild illness pathology, Stage 2: Severe illness pathology, Stage 3: Extreme illness pathology, Stage 4: Moderate illness pathology
B) Stage 1: Mild illness pathology, Stage 2: Moderate illness pathology, Stage 3: Moderate to severe illness pathology, Stage 4: Extremely severe illness pathology
C) Stage 1: Severe illness pathology, Stage 2: Moderate illness pathology, Stage 3: Mild illness pathology, Stage 4: Extremely severe illness pathology
D) Stage 1: Moderate illness pathology, Stage 2: Severe illness pathology, Stage 3: Extremely severe illness pathology, Stage 4: Mild illness pathology
B) Stage 1: Mild illness pathology, Stage 2: Moderate illness pathology, Stage 3: Moderate to severe illness pathology, Stage 4: Extremely severe illness pathology
- stage 1anorexia nervosa (mild illness pathology),
- stage 2 (moderate illness pathology),
- stage 3 (moderate to severe illness pathology)
- stage 4 (extremely severe illness pathology)
According to the BMI categories for anorexia nervosa in adults, which of the following accurately reflects the severity stages?
A) Mild: BMI > 18, Moderate: 17–17.99, Severe: 16–16.9, Extreme: < 16
B) Mild: BMI > 17, Moderate: 16–16.99, Severe: 15–15.9, Extreme: < 15
C) Mild: BMI > 19, Moderate: 18–18.99, Severe: 17–17.9, Extreme: < 17
D) Mild: BMI > 16, Moderate: 15–15.99, Severe: 14–14.9, Extreme: < 14
B) Mild: BMI > 17, Moderate: 16–16.99, Severe: 15–15.9, Extreme: < 15
Eating disorder in which the individual engages in recurrent binge eating episodes and compensatory behaviours (such as self-induced vomiting, abuse of laxatives and excessive exercise) designed to prevent
weight gain.
bulimia nervosa
Classification of bulimia nervosa in DSM-______ had few major problems:
- too broad and over-inclusive (e.g. overeating due to depression could meet the criteria for bulimia)
- overemphasis on a single behaviour (i.e., binge eating episodes) being sufficient for the diagnosis, while other eating disorder ,symptoms of importance (such as extreme weight-control behaviours/vomiting) were not an essential requirement
- confusion in their use of the term ‘bulimia’ to denote both the disorder as well as the behaviour of overeating.
3
Eating disorder in which the individual engages in recurrent binge eating episodes but does not
engage in compensatory
behaviours (such as self/induced vomiting)
designed to counteract the caloric intake.
binge eating disorder
Diagnostic criteria for BINGE EATING DSORDER:
- binge eating episodes at least ONCE WEEKLY for at least THREE MONTHS (same frequency criteria for bulimia nervosa), but not regularly engage in the inappropriate weight-control behaviours (e.g., purging) that are characteristic of bulimia nervosa.
- binge eating is required to be associated with marked distress and THREE to FIVE descriptors, namely eating more rapidly than normal, eating until uncomfortably full, eating when not hungry, eating alone because of embarrassment, or feeling disgusted, guilty or depressed after eating
Which of the following correctly represents the severity of binge eating disorder based on the weekly frequency of episodes?
A) Mild: 1–3 episodes, Moderate: 4–7 episodes, Severe: 8–13 episodes, Extreme: > 15 episodes
B) Mild: 1–3 episodes, Moderate: 4–7 episodes, Severe: 8–13 episodes, Extreme: > 14 episodes
C) Mild: 2–4 episodes, Moderate: 5–8 episodes, Severe: 9–12 episodes, Extreme: > 15 episodes
D) Mild: 1–3 episodes, Moderate: 4–6 episodes, Severe: 7–10 episodes, Extreme: > 12 episodes
B) Mild: 1–3 episodes, Moderate: 4–7 episodes, Severe: 8–13 episodes, Extreme: > 14 episodes
Disturbance of body image is important for diagnosis of binge eating disorder. True/False
False
(there is no requirement for a disturbance of body image or overvaluation of weight or shape in the diagnosis of binge eating disorder)
Practice of feeding a patient via a tube in the
case of patients who are unable or refuse to obtain nutrition by swallowing; in the case
of severely malnourished patients with anorexia nervosa,
a nasogastric tube may be used, which entails a plastic tube being inserted through the nose and throat into the
stomach.
tube feeding
A test that is used to determine the cause of difficulty with swallowing. The patient drinks a preparation containing barium
sulphate, which is a metallic compound that shows up on X-rays and is used to see abnormalities in the oesophagus and stomach.
barium swallow
- Significantly underweight
- Fears gaining weight and/or engages in behaviours to prevent weight gain
- Body image disturbance (e.g., self-worth is excessively influenced by shape/weight, lack of recognition of the seriousness of the current low weight)
Anorexia nervosa
- Binge eating episodes
- Inappropriate weight-control behaviours (e.g., self-induced vomiting)
- Self-worth is excessively influenced by shape/weight
Bulimia nervosa
- Binge eating episodes
- Marked distress regarding the binge eating
- No current regular inappropriate weight-control behaviours (e.g., self-induced vomiting)
Binge eating disorder
- A persistent eating disturbance associated with failure to meet nutritional/energy needs
- The eating disturbance cannot be explained by cultural practices, another eating
disorder, body image disturbance and/or another medical or mental health condition
Avoidant/restrictive food intake disorder (ARFID)
Other specified feeding or eating disorder (OSFED) where all of the criteria for anorexia nervosa are met
except for current underweight.
atypical anorexia nervosa
Disorder where all criteria are met except that the binge eating or weight-control behaviours occur less than once a week and/or for less than 3 months
bulimia nervosa of low frequency and/or limited duration
Eating disorder where all criteria are met
except frequency and/or duration of binge eating episodes
binge eating disorder of low frequency and/or limited duration
Recurrent purging to influence weight or shape.
purging disorder
Recurrent eating in the evening or after awakening from sleep
that is excessive and causes distress.
night eating syndrome
Symptoms characteristic of an eating disorder causing significant impairment or distress
that do not meet full criteria for another eating disorder
Unspecified feeding or eating disorder
Persistent eating of non-food substances
Pica
Repeated regurgitation of food, which may then be re-chewed, re-swallowed or spat out
Rumination disorder
The prevalence of anorexia nervosa is _____% with less than ______% currently affected.
0.9
1
Anorexia nervosa is 10 times higher in ________ (femals, males) during early to late adolescence, however pre-pubertal onset is not uncommon.
females
The mortality rate for anorexia nervosa (5–10 per cent of patients die per decade of illness)
is among the highest of all psychiatric disorders, with most deaths due to the medical
complications of
starvation or suicide. True/False
True
Recovery from anorexia nervosa is typically a lengthy process,
47% of patients recovered after 4–10 years of illness,
32.4% improved but still experienced some symptoms, and
19.7% remained
chronically ill.
Young girls with a brief history of illness tend to experience a better outcome while about
______% of patients with anorexia nervosa go on to develop bulimia nervosa, binge eating disorder or ‘other specified feeding or eating disorder’ (OSFED).
50
Which of the following psychological comorbidities is commonly observed in individuals with anorexia nervosa?
a) Major depression
b) Social phobia
c) Substance use disorders (e.g., alcohol, amphetamines)
d) Obsessive-compulsive personality disorder
e) All of the above
e) All of the above
Biological factors are insufficient to account for the development of anorexia nervosa in any one person, but they are important in increasing the risk of the disorder in otherwise vulnerable people. True/False
True
(hereditability for eating disorders is moderate and higher monozygotic versus dizygotic twins)
A familial predisposition to leanness and family histories of obsessive-compulsive personality
and mood disorders are common in anorexia nervosa patients. True/False
True
Patients with anorexia nervosa are found to have abnormally ___ levels of serotonin activity that contribute to the development of the illness by promoting undereating and over-control.
a) Low
b) High
c) Normal
d) Variable
b) High
Leptin levels have consistently been found to be significantly ___ in anorexia nervosa patients (which should increase food intake and hence weight gain) compared to normal-weight controls.
a) Lower
b) Higher
c) Normal
d) Variable
a) Lower
(probably the result of reduced body fat, since
leptin is secreted by fat cells)
Neuroimaging studies have found abnormal functioning in the ________ lobe and limbic system that may persist after recovery in individuals with anorexia nervosa.
a) Frontal
b) Occipital
c) Parietal
d) Temporal
d) Temporal
Which of the following psychological factors is associated with anorexia nervosa?
a) High self-esteem
b) Positive affect (e.g., happiness, contentment)
c) Functional thinking regarding eating (self-worth independent of body weight and shape)
d) Perfectionism (striving to unrealistically high standards)
e) All of the above
e) All of the above
Which of the following best describes the social factors contributing to the development of anorexia nervosa?
a) Only family influences are significant in the development of anorexia nervosa.
b) Peer influences and family influences are irrelevant to the development of anorexia nervosa.
c) Cultural values and societal pressures, along with family and peer influences, play a role in the development of anorexia nervosa.
d) Genetic factors are the sole contributors to the development of anorexia nervosa.
c) Cultural values and societal pressures, along with family and peer influences, play a role in the development of anorexia nervosa.
e.g.
higher levels of criticism and lower levels of care and affection
from their parents
promotion in the media of unrealistic and unhealthy levels of thinness
Which of the following are three types of treatment options for patients with anorexia nervosa?
a) Short-term inpatient treatment, day-patient treatment, outpatient treatment
b) Home-based therapy, group therapy, residential treatment
c) Cognitive-behavioral therapy, pharmacotherapy, psychoeducation
d) Long-term residential treatment, teletherapy, support groups
a) Short-term inpatient treatment, day-patient treatment, outpatient treatment
Type of psychological treatment that aims to increase the client’s intrinsic motivation to change,
_____ _______ _______ (MET).
motivational enhancement therapy
(better results for motivation than CBT)
(decisional analysis helps patients to become
more aware of the negative consequences of their illness (rather than focusing almost exclusively on
its benefits) and thus will experience greater motivation to recover)
What stage of CBT for anorexia nervosa involves normalising eating, weight and weight-control behaviours?
stage 1
What stage of CBT for anorexia nervosa involves dealing with psychological problems such as poor self-esteem, perfectionism, coping with negative emotions and
interpersonal functioning?
stage 2
What stage of CBT for anorexia nervosa involves preparing the patient for the end of treatment and developing strategies to prevent relapse (how to recognise early warning signs)?
stage 3
CBT for anorexia nervosa typically involves _____ sessions over ______ weeks.
40
40
_______ ________ is currently considered to be the treatment of choice for younger patients (children and adolescents) with anorexia nervosa.
Family therapy
Pharmacological treatment involves ______.
SSRIs
(antipsychotics and tricyclics antidepressants lack evidence and have adverse effects)
Two psychological treatments specifically adapted for individuals with severe and enduring anorexia nervosa are:
A) Cognitive Behaviour Therapy (CBT-E) and Dialectical Behavior Therapy (DBT)
B) Cognitive Behaviour Therapy (CBT-SE) and Specialist Supportive Clinical Management (SSCM-SE)
C) Acceptance and Commitment Therapy (ACT) and Interpersonal Therapy (IPT)
D) Motivational Interviewing (MI) and Family-Based Therapy (FBT)
B) Cognitive Behaviour Therapy (CBT-SE) and Specialist Supportive Clinical Management (SSCM-SE)
Both treatments were
found to be successful in promoting change in both quality of life and eating disorder symptoms, but one year after treatment ended, those patients who had received CBT-SE had lower eating disorder symptoms as well as higher motivation to recover than those who had received SSCM-SE.
(extremely low percentage (13%) of patients who did not
complete the study, which is one of the lowest attrition rates ever reported in treatment trials on anorexia nervosa).
Eating disorder characterised by the regular occurrence of binge eating episodes and inappropriate weight-control
behaviours (such as self-induced vomiting) as well as the excessive influence of shape/weight on self-worth
Bulimia nervosa
Bulimia nervosa is more prevalent in women with estimates that __-__% women will experience bulimia
nervosa at some point in their lifetime compared with 0.1–0.3 per cent of men.
1-3
The onset of bulimia nervosa is in late adolescence and young adulthood. True/False
True
Homosexuality acts as a risk factor for eating disorders in men. True/False
True
(20% of males with an eating disorder are homosexual)
The symptoms of bulimia nervosa can be chronic, with ____% of patients still have the disorder after 10 years.
50
(Poorer outcomes are reported where there is a history of childhood obesity, low self-esteem or a personality disorder)
Which of the following biological factors are associated with bulimia nervosa?
A) Heritability (moderate), familial predisposition to obesity, and family histories of substance use and mood disorders
B) Strong heritability, lack of familial predisposition to obesity, and family histories of anxiety disorders
C) Low heritability, familial predisposition to diabetes, and family histories of schizophrenia
D) No heritability, familial predisposition to eating disorders, and family histories of psychotic disorders
A) Heritability (moderate), familial predisposition to obesity, and family histories of substance use and mood disorders
Serotonin levels in those with bulimia nervosa are found to be lower/higher?
lower
(reduced serotonin activity has been found to be associated with increased appetite and
decreased impulse control)
What is the main distinction in familial predisposition between anorexia nervosa and bulimia nervosa?
A) Higher rate of bipolar disorder in the family members of those with anorexia nervosa, and of anxiety disorders in bulimia nervosa
B) Higher rate of obsessive-compulsive personality disorder in the family members of those with anorexia nervosa, and of substance use disorders in bulimia nervosa
C) Higher rate of depression in the family members of those with anorexia nervosa, and of schizophrenia in bulimia nervosa
D) Higher rate of eating disorders in the family members of those with anorexia nervosa, and of personality disorders in bulimia nervosa
B) Higher rate of obsessive-compulsive personality disorder in the family members of those with anorexia nervosa, and of substance use disorders in bulimia nervosa
Which psychological factors (dual pathway model) are involved in bulimia nervosa, and how do they influence binge eating?
A) Dieting and low self-esteem (both factors operate independently but not interactively to cause binge eating)
B) Dieting and negative affect (these factors operate independently and also interact with each other to cause binge eating)
C) High self-esteem and stress (these factors operate independently and in interaction to cause binge eating)
D) Dieting and positive mood (these factors operate interactively but not independently to cause binge eating)
B) Dieting and negative affect (these factors operate independently and also interact with each other to cause binge eating)
